| NPI | 1134725146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 58605) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 1146702) |
| 363L00000X Nurse Practitioner (Licence: KY 3015715) | |
| 363LF0000X Nurse Practitioner, Family (Licence: KY 3015715) | |
| Enumeration Date | 2020-12-07 |
| Last Update Date | 2021-11-15 |