| 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 |