| NPI | 1306850862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: KY 3003375) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: KY 3375P) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2021-11-08 |