| NPI | 1982612354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: KY 33944) |
| Additional Taxonomies | 363LX0001X Nurse Practitioner, Obstetrics & Gynecology (Licence: KY 78903804) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2014-03-24 |