| NPI | 1407379043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: IN 71007420A) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: KY 3011669) |
| Enumeration Date | 2017-07-25 |
| Last Update Date | 2022-07-21 |