| NPI | 1558669606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: KY 3006890) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: KY 2010005782) |
| Enumeration Date | 2011-03-13 |
| Last Update Date | 2012-03-20 |