| NPI | 1275925547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5013115) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: OH 16681NP) |
| 363LA2100X Nurse Practitioner Acute Care (Licence: KY 3009626) | |
| Enumeration Date | 2015-02-24 |
| Last Update Date | 2020-07-27 |