| NPI | 1366610826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3005287) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 5287P) |
| Enumeration Date | 2008-02-18 |
| Last Update Date | 2021-01-27 |