| NPI | 1427475722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3008482) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 71005258A) |
| Enumeration Date | 2014-03-25 |
| Last Update Date | 2019-03-12 |