| NPI | 1821493347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3008867) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 71005248A) |
| Enumeration Date | 2014-10-27 |
| Last Update Date | 2023-11-22 |