| NPI | 1326891656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 4029417) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 790476) |
| 163WH0200X Registered Nurse, Home Health (Licence: KY 1167142) | |
| Enumeration Date | 2024-04-08 |
| Last Update Date | 2024-10-22 |