| NPI | 1952746067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: OH COA.14306-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.388869-COA1) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: OH COA.14306-NP) | |
| Enumeration Date | 2013-05-02 |
| Last Update Date | 2021-01-15 |