| NPI | 1245542331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: KY 3006511) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3006511) |
| Enumeration Date | 2010-07-06 |
| Last Update Date | 2018-06-05 |