NPI | 1831397884 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.09471-NP) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN 272088-COA1) |
Enumeration Date | 2007-07-10 |
Last Update Date | 2014-04-24 |