| NPI | 1598226045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3013320) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: VA 0024177387) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: VA 0024177387) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024177387) | |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2023-03-15 |