| NPI | 1134699838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 4018518) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 4018518) |
| 246ZC0007X Specialist/Technologist, Other, Surgical Assistant | |
| Enumeration Date | 2018-11-26 |
| Last Update Date | 2024-04-23 |