| NPI | 1891701835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: KY 3004876) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1096562) |
| 363L00000X Nurse Practitioner (Licence: KY 3004876) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2019-02-14 |