| NPI | 1659827400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: KY 3010623) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3010623) |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2023-08-18 |