| NPI | 1518610724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3017489) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1129505) |
| 363L00000X Nurse Practitioner (Licence: KY 1129505) | |
| Enumeration Date | 2022-01-28 |
| Last Update Date | 2022-03-02 |