NPI | 1154525137 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.08521-NP) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH RN.295875-COA1) |
Enumeration Date | 2007-06-13 |
Last Update Date | 2020-05-06 |