| NPI | 1154812717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH 022670) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: OH 022670) |
| 363L00000X Nurse Practitioner (Licence: KY 4005911) | |
| Enumeration Date | 2018-05-19 |
| Last Update Date | 2023-09-22 |