| NPI | 1285293548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3013399) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11014219) |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2023-03-02 |