| NPI | 1184959132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3006288) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: KY 3006288) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5005302) | |
| Enumeration Date | 2009-10-08 |
| Last Update Date | 2022-06-09 |