NPI | 1912399486 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3009269) |
Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: KY 3009269) |
Enumeration Date | 2015-02-20 |
Last Update Date | 2021-08-12 |