NPI | 1851684674 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: OH 17756) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 353367) |
Enumeration Date | 2011-05-26 |
Last Update Date | 2015-07-23 |