| NPI | 1356345045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3003251) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3251P) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2022-07-20 |