| NPI | 1821383159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5011071) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: KY 3006748) |
| 363LF0000X Nurse Practitioner, Family (Licence: KY 3006748) | |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2022-01-25 |