Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | R224463 | MD |
NPI | 1033882774 |
---|---|
Provider Name | Kenneth Kibiriu |
First Address | Baltimore, MD 21236-4609 |
Second Address | Baltimore, MD 21236-4609 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2021 |
Last Update Date | 28/07/2021 |