NPI | 1295443612 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0032461) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209030481) |
363LF0000X Nurse Practitioner, Family (Licence: IN 71015724A) | |
Enumeration Date | 2022-11-15 |
Last Update Date | 2024-10-15 |