| NPI | 1568711927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: KY 3007641) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3007641) |
| Enumeration Date | 2012-08-31 |
| Last Update Date | 2014-04-24 |