| NPI | 1447227285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: WV 50644) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 4411P) |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2021-04-22 |