NPI | 1386849818 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.08953) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH COA.08953-NP) |
Enumeration Date | 2007-06-15 |
Last Update Date | 2024-10-14 |