| NPI | 1124228226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH 021248) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH 021248) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: OH 021248) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: OH 021248) | |
| Enumeration Date | 2007-07-18 |
| Last Update Date | 2023-06-02 |