| NPI | 1982218848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.0027792) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.397473) |
| Enumeration Date | 2020-09-08 |
| Last Update Date | 2020-10-16 |