| NPI | 1801461793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WN0002X Registered Nurse, Neonatal Intensive Care (Licence: OH RN.446630) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0029344) |
| Enumeration Date | 2021-05-24 |
| Last Update Date | 2021-07-30 |