| NPI | 1316364334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3008586) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 18173) |
| Enumeration Date | 2014-03-27 |
| Last Update Date | 2014-03-27 |