NPI | 1689331373 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3017048) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1175148) |
363LF0000X Nurse Practitioner, Family (Licence: KY 3017048) | |
Enumeration Date | 2021-11-17 |
Last Update Date | 2022-12-19 |