| NPI | 1154716769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 4024541) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SC 19388) |
| 207P00000X Emergency Medicine (Licence: KY 4024541) | |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2024-11-19 |