NPI | 1811549306 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3016250) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 30126250) |
363L00000X Nurse Practitioner (Licence: IN 71011063A) | |
363LF0000X Nurse Practitioner, Family (Licence: IN 71011063A) | |
363LF0000X Nurse Practitioner, Family (Licence: AZ 228482) | |
Enumeration Date | 2019-07-15 |
Last Update Date | 2022-09-08 |