| NPI | 1356796205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3009361) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 3009361) |
| Enumeration Date | 2016-04-28 |
| Last Update Date | 2025-02-24 |