| NPI | 1225697261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: OH 024788) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: OH 024788) |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2024-10-10 |