| NPI | 1285097220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: KY 3010202) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: KY 3010202) |
| 363LF0000X Nurse Practitioner, Family (Licence: KY 3010202) | |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2021-02-22 |