| NPI | 1598278087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3011839) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 71007664A) |
| Enumeration Date | 2017-11-07 |
| Last Update Date | 2019-04-18 |