| NPI | 1821382284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3006952) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3006952) |
| Enumeration Date | 2011-06-02 |
| Last Update Date | 2020-12-02 |