| NPI | 1831422039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3011842) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 164344) |
| Enumeration Date | 2009-09-08 |
| Last Update Date | 2018-03-17 |