| NPI | 1932416948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3006897) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WV 59306) |
| Enumeration Date | 2010-09-13 |
| Last Update Date | 2012-03-20 |