NPI | 1629744800 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3016426) |
Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: KY 3016426) |
Enumeration Date | 2021-08-18 |
Last Update Date | 2024-04-10 |