| NPI | 1851661102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3007595) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 71003836a) |
| 363L00000X Nurse Practitioner (Licence: IN 71003836A) | |
| Enumeration Date | 2012-01-04 |
| Last Update Date | 2025-05-02 |