NPI | 1104343235 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3011300) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.020842) |
363L00000X Nurse Practitioner (Licence: IN 71013534A) | |
Enumeration Date | 2017-08-29 |
Last Update Date | 2023-04-12 |