| NPI | 1023400413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3012509) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 339315) |
| Enumeration Date | 2015-02-23 |
| Last Update Date | 2018-10-01 |