NPI | 1417524083 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0026858) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH APRN.CNP.0026858) |
363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0026858) | |
363LP0200X Nurse Practitioner, Pediatrics (Licence: OH APRN.CNP.0026858) | |
363LP2300X Nurse Practitioner, Primary Care (Licence: OH APRN.CNP.0026858) | |
Enumeration Date | 2021-06-10 |
Last Update Date | 2021-08-24 |