| NPI | 1831416502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 4005867) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN3117322) |
| Enumeration Date | 2010-04-21 |
| Last Update Date | 2023-10-26 |