| NPI | 1528158649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3004391) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 4391P) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2014-11-06 |