| NPI | 1932198124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3004151) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3004151) |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2019-02-21 |