| NPI | 1326453150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: OH APRN.CNP.16107) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH COA.16107-NP) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: OH APRN.CNP.16107) | |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2021-10-22 |