| 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 |