| NPI | 1497107403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: KY 3011914) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3011914) |
| 363LF0000X Nurse Practitioner, Family (Licence: IN 71006358A) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KY 3011914) | |
| Enumeration Date | 2016-07-01 |
| Last Update Date | 2023-09-27 |