| NPI | 1790329910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: OH APRN.CNP.024041) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: OH APRN.CNP.024041) |
| 363LG0600X Nurse Practitioner Gerontology (Licence: OH APRN.CNP.024041) | |
| Enumeration Date | 2019-10-31 |
| Last Update Date | 2022-01-20 |