| NPI | 1750761953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: OH 2015003091) |
| Additional Taxonomies | 364SG0600X Clinical Nurse Specialist Gerontology (Licence: OH 2015003091) |
| 163W00000X Registered Nurse (Licence: OH RN.399355) | |
| Enumeration Date | 2015-06-02 |
| Last Update Date | 2015-08-13 |