| NPI | 1891125266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH APRN.CNP.0028238) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: OH 397254) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: OH APRN.CNP.0028238) | |
| Enumeration Date | 2013-11-20 |
| Last Update Date | 2021-11-18 |