NPI | 1740026137 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 4025567) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1167714) |
Enumeration Date | 2024-07-03 |
Last Update Date | 2024-12-10 |