| NPI | 1154902922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: OH AG03210086) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: OH APRN.CNP.0028609) |
| Enumeration Date | 2021-04-14 |
| Last Update Date | 2022-01-27 |