| NPI | 1619489952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: KY 3011614) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3011614) |
| Enumeration Date | 2017-10-26 |
| Last Update Date | 2023-10-27 |