| NPI | 1982042073 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN11041407) | 
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.14542) | 
| Enumeration Date | 2013-06-11 | 
| Last Update Date | 2025-08-15 |