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 |