| NPI | 1720446115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3010190) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1126366) |
| Enumeration Date | 2016-02-01 |
| Last Update Date | 2016-04-08 |