| NPI | 1497842009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: KY 1051982) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: KY 4172P) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2007-07-08 |