| NPI | 1518157742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3342P) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3003342) |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2011-01-10 |