| NPI | 1992071732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3018796) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA SP011981) |
| Enumeration Date | 2012-03-27 |
| Last Update Date | 2025-08-26 |