| NPI | 1134715071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3015580) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.0028121) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: KY 3015580) | |
| Enumeration Date | 2020-12-15 |
| Last Update Date | 2023-07-24 |