| NPI | 1750998985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3015821) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1169233) |
| 363LF0000X Nurse Practitioner, Family (Licence: TN 29413) | |
| Enumeration Date | 2020-10-01 |
| Last Update Date | 2022-10-05 |