| NPI | 1043445927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 43704) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT194879) |
| 207Q00000X Family Medicine (Licence: IN 01068828A.) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: KY 43704) | |
| Enumeration Date | 2009-05-21 |
| Last Update Date | 2018-08-22 |