| NPI | 1336419993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: KY 3007284) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 26846) |
| Enumeration Date | 2012-01-12 |
| Last Update Date | 2022-09-22 |