| NPI | 1003027228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: KY 3010370) |
| Additional Taxonomies | 163WR0006X Registered Nurse Registered Nurse First Assistant (Licence: KY 1090199) |
| 363LF0000X Nurse Practitioner Family (Licence: IN 28143085A) | |
| Enumeration Date | 2007-05-28 |
| Last Update Date | 2023-07-28 |