NPI | 1922604560 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH 0028218) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 240801) |
163W00000X Registered Nurse (Licence: OH 484230) | |
363LA2100X Nurse Practitioner, Acute Care (Licence: TN 28513) | |
Enumeration Date | 2020-12-09 |
Last Update Date | 2021-01-01 |