NPI | 1033586680 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: OH APRN.CNP.18027) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH COA18027NP) |
Enumeration Date | 2015-08-31 |
Last Update Date | 2025-03-28 |