NPI | 1194360578 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3014042) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 3014042) |
Enumeration Date | 2019-11-09 |
Last Update Date | 2020-02-10 |