NPI | 1972959146 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 163W00000X Registered Nurse (Licence: OH RN.382328) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.019720) |
Enumeration Date | 2016-05-06 |
Last Update Date | 2016-09-09 |