| NPI | 1528471802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3014126) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 20527) |
| 363L00000X Nurse Practitioner (Licence: NC MCGO-DPB4NY) | |
| 363L00000X Nurse Practitioner (Licence: SC 18844) | |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2021-06-30 |