NPI | 1427146562 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3002990) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.05468) |
Enumeration Date | 2006-10-11 |
Last Update Date | 2022-12-02 |