| NPI | 1336741750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 4006618) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1116428) |
| Enumeration Date | 2020-11-10 |
| Last Update Date | 2023-11-20 |