| NPI | 1942687074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0041572) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 306964) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: OH APRN.CNP.0041572) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: NY 306964) | |
| Enumeration Date | 2015-04-27 |
| Last Update Date | 2026-06-09 |