NPI | 1376091223 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3010741) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 3010741) |
Enumeration Date | 2016-09-20 |
Last Update Date | 2020-02-19 |