NPI | 1962805853 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH 0027536) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN394733) |
Enumeration Date | 2014-10-06 |
Last Update Date | 2021-06-11 |