NPI | 1003151150 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH 13506-NP) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3007555) |
Enumeration Date | 2012-11-30 |
Last Update Date | 2015-10-26 |