| NPI | 1013488253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3012697) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3012697) |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2022-01-03 |