| NPI | 1275157539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3014729) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 56919) |
| Enumeration Date | 2020-06-02 |
| Last Update Date | 2025-02-19 |