| NPI | 1932169752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3002658) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 8377) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2012-03-22 |