| NPI | 1912788092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.0035160) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: PA RN716224) |
| Enumeration Date | 2023-10-13 |
| Last Update Date | 2023-10-13 |