NPI | 1104328343 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61071709) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.022391) |
Enumeration Date | 2018-03-04 |
Last Update Date | 2023-10-26 |