NPI | 1396252946 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.022047) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704339712) |
Enumeration Date | 2018-01-04 |
Last Update Date | 2023-11-03 |