NPI | 1457601650 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3010545) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH COA13811NP) |
Enumeration Date | 2012-09-14 |
Last Update Date | 2021-05-28 |