| NPI | 1578933883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: KY 3009777) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3009777) |
| Enumeration Date | 2015-09-29 |
| Last Update Date | 2024-01-24 |