NPI | 1184390775 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0029614) |
Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: OH rn.347647) |
Enumeration Date | 2021-08-23 |
Last Update Date | 2025-02-14 |