NPI | 1821493347 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3008867) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 71005248A) |
Enumeration Date | 2014-10-27 |
Last Update Date | 2023-11-22 |