| NPI | 1912627365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.0032239) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 453130) |
| Enumeration Date | 2022-08-29 |
| Last Update Date | 2022-09-09 |