NPI | 1720778079 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH Aprn.Cnp.0033744) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0033744) |
Enumeration Date | 2023-05-10 |
Last Update Date | 2024-08-23 |