NPI | 1215316831 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3009416) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3009416) |
Enumeration Date | 2015-05-28 |
Last Update Date | 2023-07-14 |