NPI | 1851461685 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3004237) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 4237P) |
363LF0000X Nurse Practitioner, Family (Licence: KY 4237P) | |
Enumeration Date | 2006-11-09 |
Last Update Date | 2024-12-19 |