| NPI | 1972121283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3013941) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3013941) |
| 363LF0000X Nurse Practitioner, Family (Licence: IN 71010170A) | |
| 363L00000X Nurse Practitioner (Licence: IN 71010170A) | |
| Enumeration Date | 2020-07-13 |
| Last Update Date | 2024-12-24 |