NPI | 1497105001 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3010309) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3010309) |
Enumeration Date | 2016-06-14 |
Last Update Date | 2023-03-07 |