NPI | 1689160228 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ME CNP221305) |
Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: OH APRN.CNP.022479) |
Enumeration Date | 2018-07-06 |
Last Update Date | 2022-12-20 |