NPI | 1598132003 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH 18152) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH RN 382984) |
363L00000X Nurse Practitioner (Licence: KY 3011557) | |
Enumeration Date | 2015-09-01 |
Last Update Date | 2021-11-23 |