| NPI | 1851461685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3004237) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 4237P) |
| 363LF0000X Nurse Practitioner, Family (Licence: KY 4237P) | |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2019-06-11 |