NPI | 1841769700 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3012929) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.024016) |
363LF0000X Nurse Practitioner, Family (Licence: WV 58355) | |
Enumeration Date | 2018-11-20 |
Last Update Date | 2023-11-27 |