| NPI | 1275991663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3010057) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP143110) |
| Enumeration Date | 2016-02-01 |
| Last Update Date | 2020-10-23 |