| NPI | 1174142103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3014332) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: KY 3014332) |
| Enumeration Date | 2020-04-09 |
| Last Update Date | 2026-01-08 |