| NPI | 1689701898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3003216) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3216P) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2019-10-29 |