| NPI | 1205646676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: KY 4035311) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1153868) |
| Enumeration Date | 2025-01-08 |
| Last Update Date | 2025-02-12 |