| NPI | 1679001622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY APRN.3011471) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3011471) |
| Enumeration Date | 2017-06-02 |
| Last Update Date | 2024-04-30 |