| NPI | 1982007720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH COA.16230-NP) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: OH COA.16230-NP) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: OH COA.16230-NP) | |
| Enumeration Date | 2014-10-08 |
| Last Update Date | 2020-03-26 |