| NPI | 1659773463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: KY 3008815) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: KY 1116169) |
| Enumeration Date | 2014-09-24 |
| Last Update Date | 2016-10-20 |