| NPI | 1699213868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: KY 3011459) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3011459) |
| 363LF0000X Nurse Practitioner Family (Licence: TN 30565) | |
| Enumeration Date | 2017-02-07 |
| Last Update Date | 2022-01-14 |