| NPI | 1396375952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3014140) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 3014140) |
| Enumeration Date | 2020-01-23 |
| Last Update Date | 2024-11-05 |