| NPI | 1528214749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71002728A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3007791) |
| Enumeration Date | 2008-08-08 |
| Last Update Date | 2024-11-05 |