NPI | 1568711927 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3007641) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3007641) |
Enumeration Date | 2012-08-31 |
Last Update Date | 2014-04-24 |