| NPI | 1568136117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: KY 3015149) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: KY 3015149) |
| Enumeration Date | 2021-08-06 |
| Last Update Date | 2021-09-02 |