| NPI | 1538149596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3004609) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 4609P) |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2019-01-16 |