| NPI | 1255419776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3002659) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 2659P) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2023-06-13 |