| NPI | 1124843131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: KY 4035739) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: KY 1160997) |
| Enumeration Date | 2024-11-15 |
| Last Update Date | 2025-02-25 |