| NPI | 1700169117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 364SG0600X Clinical Nurse Specialist, Gerontology (Licence: OH APRN.CNS.019314) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 316816) |
| Enumeration Date | 2011-09-21 |
| Last Update Date | 2017-01-11 |