| NPI | 1619381092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3008699) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11010350) |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2024-05-15 |