NPI | 1154751949 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71006081A) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1119693) |
363LF0000X Nurse Practitioner, Family (Licence: KY 3008345) | |
Enumeration Date | 2013-11-15 |
Last Update Date | 2022-07-12 |