| NPI | 1275933574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: OH APRN.CNP.15990) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH COA.15990-NP) |
| Enumeration Date | 2014-08-25 |
| Last Update Date | 2020-11-23 |