NPI | 1255743001 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.15936-NP) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.364569) |
Enumeration Date | 2014-05-28 |
Last Update Date | 2022-01-25 |