| NPI | 1871068056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.0039711) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 265836) |
| Enumeration Date | 2018-10-03 |
| Last Update Date | 2026-07-22 |