NPI | 1184879736 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3003519) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH 10395) |
363L00000X Nurse Practitioner (Licence: IN 71001655A) | |
363LF0000X Nurse Practitioner, Family (Licence: OH 10395) | |
Enumeration Date | 2008-11-24 |
Last Update Date | 2024-06-14 |