| NPI | 1598937229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3005643) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1096442) |
| Enumeration Date | 2008-04-02 |
| Last Update Date | 2016-02-03 |