| NPI | 1194041897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3006425) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 6425P) |
| Enumeration Date | 2010-04-20 |
| Last Update Date | 2024-01-10 |