| NPI | 1992257794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH APRN.CNP.020129) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: OH APRN.CNP.020129) |
| Enumeration Date | 2016-10-27 |
| Last Update Date | 2021-01-06 |