| NPI | 1275558934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3003831) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: KY p3831) |
| 363LF0000X Nurse Practitioner, Family (Licence: KY p3003831) | |
| 363LF0000X Nurse Practitioner, Family (Licence: OH 16864-NP) | |
| 363LX0001X Nurse Practitioner, Obstetrics & Gynecology (Licence: KY p3831) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2020-02-14 |