| NPI | 1508854209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: KY 3003766) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: IN 99008560A) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: IN 71001726A) | |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2011-01-11 |