| NPI | 1275677379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: OH 263369) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner Gerontology (Licence: OH 263369) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2020-06-26 |