NPI | 1669849956 |
---|---|
Other Name | BUTCH LEROY |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2015029764) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 78890) |
363L00000X Nurse Practitioner (Licence: IL 209016256) | |
Enumeration Date | 2015-08-21 |
Last Update Date | 2022-02-16 |