| NPI | 1578192274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY APRN3014401) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3014401) |
| Enumeration Date | 2020-04-04 |
| Last Update Date | 2021-11-09 |