NPI | 1629701685 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH 0031825) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 377352) |
Enumeration Date | 2022-07-07 |
Last Update Date | 2022-07-20 |