| NPI | 1750952867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0029271) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: OH APRN.CNP.0029271) |
| 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: OH APRN.CNP.0029271) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-07-09 |
| Last Update Date | 2021-08-26 |