| NPI | 1912372194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: OH COA.18481-NP) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH COA.18481-NP) |
| Enumeration Date | 2015-12-14 |
| Last Update Date | 2024-10-12 |