| NPI | 1134687536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 4019014) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.024218) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 1114090) | |
| 363L00000X Nurse Practitioner (Licence: KY 4019014) | |
| Enumeration Date | 2019-03-05 |
| Last Update Date | 2025-09-23 |