NPI | 1750869061 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH CNP.0031949) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ME CNP181152) |
Enumeration Date | 2018-07-31 |
Last Update Date | 2022-08-27 |