| NPI | 1427409663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.19022) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH AG0316107) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: OH AG0316107) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: OH AG0316107) | |
| Enumeration Date | 2016-06-29 |
| Last Update Date | 2017-04-28 |