NPI | 1427305036 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0033164) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 9277514) |
363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0033164) | |
Enumeration Date | 2012-08-14 |
Last Update Date | 2023-11-14 |