| NPI | 1487177895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: SC 21264) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3018058) |
| 363LA2100X Nurse Practitioner Acute Care (Licence: SC 21264) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-07-18 |
| Last Update Date | 2022-11-07 |