| NPI | 1184700189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3003504) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 28258168A) |
| 363LF0000X Nurse Practitioner, Family (Licence: OH 268276 NP-08262) | |
| 363LF0000X Nurse Practitioner, Family (Licence: WY 23436.0826) | |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2025-02-13 |