| NPI | 1497044283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3008845) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN F0910217) |
| Enumeration Date | 2011-04-01 |
| Last Update Date | 2022-03-21 |