| NPI | 1740026137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: KY 4025567) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1167714) |
| 363L00000X Nurse Practitioner (Licence: KY 4025567) | |
| Enumeration Date | 2024-07-03 |
| Last Update Date | 2024-08-20 |