NPI | 1326751652 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0032941) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3018831) |
Enumeration Date | 2023-01-02 |
Last Update Date | 2023-06-27 |