| NPI | 1598442352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3018923) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH 0031082) |
| Enumeration Date | 2023-07-03 |
| Last Update Date | 2024-03-18 |