| NPI | 1922728849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3018279) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: KY 3018279) |
| 363LF0000X Nurse Practitioner, Family (Licence: KY 3018279) | |
| Enumeration Date | 2022-08-31 |
| Last Update Date | 2022-09-28 |