NPI | 1417905530 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3003001) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH 06154) |
Enumeration Date | 2006-05-04 |
Last Update Date | 2023-08-30 |