| NPI | 1922594167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: OH APRN.CNP.023101) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH APRN.CNP.023101) |
| 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.023101) | |
| Enumeration Date | 2018-07-10 |
| Last Update Date | 2025-04-03 |