| NPI | 1609256361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: KY 3009278) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3009278) |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2020-06-10 |