NPI | 1568089043 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH 0027182) |
Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: OH 409226) |
Enumeration Date | 2020-06-30 |
Last Update Date | 2020-09-23 |