| NPI | 1982666897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 2569P) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 1044110) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2008-02-27 |