| NPI | 1255906392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3016302) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: KY 3016302) |
| 363L00000X Nurse Practitioner (Licence: IN 71014904A) | |
| Enumeration Date | 2021-05-21 |
| Last Update Date | 2024-03-26 |