| NPI | 1275018459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3012857) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1153069) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: KY 3012857) | |
| Enumeration Date | 2018-10-03 |
| Last Update Date | 2023-07-07 |