| NPI | 1245822303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: KY 4000472) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1161299) |
| Enumeration Date | 2021-02-09 |
| Last Update Date | 2023-05-10 |