| NPI | 1598379760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3016017) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1118082) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: KY 3016017) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: KY 3016017) | |
| Enumeration Date | 2020-09-03 |
| Last Update Date | 2021-12-14 |