| NPI | 1336490895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3007688) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: KY 0000011004) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: IN 28148103A) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: KY 3007688) | |
| 367A00000X Advanced Practice Midwife (Licence: IN 28148103A) | |
| Enumeration Date | 2012-09-25 |
| Last Update Date | 2023-03-17 |