NPI | 1518345149 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH COA17723NP) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 375877) |
Enumeration Date | 2015-05-14 |
Last Update Date | 2015-07-29 |