NPI | 1639223811 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH 102341) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 290596) |
Enumeration Date | 2007-01-23 |
Last Update Date | 2015-06-05 |