| NPI | 1366751455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3006633) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 6633P) |
| Enumeration Date | 2010-10-07 |
| Last Update Date | 2022-05-25 |