NPI | 1275677379 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: OH 263369) |
Additional Taxonomies | 363LG0600X Nurse Practitioner Gerontology (Licence: OH 263369) |
Enumeration Date | 2007-02-20 |
Last Update Date | 2020-06-26 |