| NPI | 1639818867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 4014131) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1171048) |
| 163WP0200X Registered Nurse, Pediatrics (Licence: KY 1171048) | |
| Enumeration Date | 2022-06-04 |
| Last Update Date | 2024-01-08 |