NPI | 1790191914 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0036883) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AR A004092) |
Enumeration Date | 2014-07-08 |
Last Update Date | 2024-07-19 |