NPI | 1336336106 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.09544) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP009855) |
363LF0000X Nurse Practitioner, Family (Licence: MI 4704309797) | |
363LF0000X Nurse Practitioner, Family (Licence: OH COA.09544-NP) | |
Enumeration Date | 2007-09-26 |
Last Update Date | 2023-11-01 |