NPI | 1922385954 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH 2010005436) |
Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: OH 20100161) |
Enumeration Date | 2011-11-04 |
Last Update Date | 2011-12-09 |