| NPI | 1376091223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3010741) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 3010741) |
| Enumeration Date | 2016-09-20 |
| Last Update Date | 2020-02-19 |