| NPI | 1699090514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3006418) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3006418) |
| Enumeration Date | 2010-04-03 |
| Last Update Date | 2026-05-18 |