| NPI | 1821551631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH 024519) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: OH 370315) |
| 363L00000X Nurse Practitioner (Licence: OH 024519) | |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2023-11-15 |