| NPI | 1811051014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3009921) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN APN0000007805) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2018-06-06 |