| NPI | 1548747884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: KY 3012524) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner Gerontology (Licence: KY 3012524) |
| Enumeration Date | 2018-07-19 |
| Last Update Date | 2018-07-19 |