| NPI | 1386361236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: OH APRN.CNP.0032934) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.0032934) |
| 163W00000X Registered Nurse (Licence: OH RN.451691) | |
| Enumeration Date | 2022-10-21 |
| Last Update Date | 2024-10-12 |