| NPI | 1063512077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71003826A) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: KY 42960) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: IN 71003826A) | |
| 363L00000X Nurse Practitioner (Licence: KY 42960) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2024-03-15 |