| NPI | 1881251858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: OH APRN.CNP.024916) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: OH RN.413177) |
| 363LA2100X Nurse Practitioner Acute Care (Licence: KY 3014347) | |
| Enumeration Date | 2019-05-24 |
| Last Update Date | 2021-01-26 |