| NPI | 1740727239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: KY 3011064) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3011064) |
| Enumeration Date | 2017-01-23 |
| Last Update Date | 2018-03-02 |