NPI | 1720720758 |
---|---|
Former Name | KENNETH LARUE LOWERY |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 171000000X Military Health Care Provider |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2022-04-11 |
Last Update Date | 2023-08-18 |