NPI | 1750817557 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 57849) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 9589355-3102) |
Enumeration Date | 2017-05-11 |
Last Update Date | 2020-09-01 |