| NPI | 1942775838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3012743) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 71008869A) |
| Enumeration Date | 2018-10-08 |
| Last Update Date | 2019-11-26 |