| 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 |