| NPI | 1891317186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0027672) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: OH NP55555) |
| Enumeration Date | 2020-05-11 |
| Last Update Date | 2020-11-02 |