| NPI | 1518586478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3014486) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 28707) |
| Enumeration Date | 2020-04-10 |
| Last Update Date | 2021-05-18 |