| NPI | 1215613195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 4006228) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 4006228) |
| Enumeration Date | 2023-06-26 |
| Last Update Date | 2024-01-19 |