| NPI | 1467854521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 57108) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL ARNP9366348) |
| 207Q00000X Family Medicine (Licence: FL ME153714) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: FL ARNP9366348) | |
| 208M00000X Hospitalist (Licence: KY 57108) | |
| 207Q00000X Family Medicine (Licence: FL TRN29893) | |
| Enumeration Date | 2014-09-20 |
| Last Update Date | 2026-09-01 |