| NPI | 1154751949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71006081A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1119693) |
| 363LF0000X Nurse Practitioner, Family (Licence: KY 3008345) | |
| Enumeration Date | 2013-11-15 |
| Last Update Date | 2022-07-12 |