| NPI | 1295167351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 17687) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3009879) |
| Enumeration Date | 2013-07-31 |
| Last Update Date | 2016-06-30 |