| NPI | 1598171563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3017310) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 18526) |
| Enumeration Date | 2014-07-10 |
| Last Update Date | 2023-09-19 |