| NPI | 1285252205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3014719) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 71010267A) |
| Enumeration Date | 2020-07-07 |
| Last Update Date | 2020-08-12 |