NPI | 1063739621 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: AR A02941) |
Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: OH COA 09013-NP) |
Enumeration Date | 2010-04-22 |
Last Update Date | 2012-11-05 |