NPI | 1720446115 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3010190) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1126366) |
Enumeration Date | 2016-02-01 |
Last Update Date | 2016-04-08 |