NPI | 1083146336 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH APRN.CNP.020167) |
Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: OH APRN.CNP.020167) |
363LP2300X Nurse Practitioner, Primary Care (Licence: OH APRN.CNP.020167) | |
Enumeration Date | 2017-03-28 |
Last Update Date | 2017-05-12 |