| NPI | 1740698091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: OH APRN.CNP.16340) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH COA.16340-NP) |
| Enumeration Date | 2014-07-31 |
| Last Update Date | 2021-01-15 |