| NPI | 1730835968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3016629) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 3016629) |
| Enumeration Date | 2022-02-25 |
| Last Update Date | 2022-06-10 |