| NPI | 1821595059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: UT 13493666-4405) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.022957) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.022957) | |
| Enumeration Date | 2018-04-13 |
| Last Update Date | 2024-06-12 |