| NPI | 1346234259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3004190) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1092268) |
| 163W00000X Registered Nurse (Licence: IN 28156953A) | |
| 363L00000X Nurse Practitioner (Licence: KY 4190P) | |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2021-09-17 |