| NPI | 1710638689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: KY 4035870) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1136286) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: NH 087388-23) | |
| Enumeration Date | 2022-01-12 |
| Last Update Date | 2025-05-05 |