NPI | 1275018459 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3012857) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1153069) |
363LG0600X Nurse Practitioner, Gerontology (Licence: KY 3012857) | |
Enumeration Date | 2018-10-03 |
Last Update Date | 2023-07-07 |