NPI | 1164471926 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3002206) |
Additional Taxonomies | 163WG0600X Registered Nurse, Gerontology (Licence: TN 0242744-23) |
Enumeration Date | 2006-05-09 |
Last Update Date | 2018-07-16 |