NPI | 1396200523 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP024148) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH 024148) |
Enumeration Date | 2019-02-01 |
Last Update Date | 2019-02-01 |