NPI | 1124120035 |
---|---|
Entity Type | Individual |
Gender | N/A |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3002560) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 2560P) |
Enumeration Date | 2006-09-01 |
Last Update Date | 2019-01-16 |