| NPI | 1841984556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0034008) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH 00046836) |
| Enumeration Date | 2023-06-06 |
| Last Update Date | 2024-09-20 |