NPI | 1669628608 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: SC 23553) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.0500406-CR) |
101YP2500X Counselor, Professional (Licence: OH C.0500406-CR) | |
363LF0000X Nurse Practitioner, Family (Licence: SC 23553) | |
Enumeration Date | 2008-08-11 |
Last Update Date | 2020-11-11 |