| NPI | 1598107476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: KY 3006930) |
| Additional Taxonomies | 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: KY 3006930) |
| Enumeration Date | 2013-07-22 |
| Last Update Date | 2022-07-20 |