NPI | 1639558711 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.17410) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.273386) |
Enumeration Date | 2015-05-22 |
Last Update Date | 2015-09-17 |