Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | 1784 | NE |
NPI | 1760804090 |
---|---|
Provider Name | Dr. Dylan Driver |
First Address | Columbus, NE 68601-3305 |
Second Address | Columbus, NE 68601-3305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2014 |
Last Update Date | 28/12/2021 |