| NPI | 1417357286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: KY 3008891) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3008891) |
| 363LA2100X Nurse Practitioner Acute Care (Licence: KY 3008891) | |
| Enumeration Date | 2014-08-29 |
| Last Update Date | 2018-08-23 |