| NPI | 1427579895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95025972) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: WA AP61417380) |
| 163W00000X Registered Nurse (Licence: OH RN424716) | |
| 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.021530) | |
| Enumeration Date | 2017-07-06 |
| Last Update Date | 2025-12-17 |