| NPI | 1831802438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3018133) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71014878A) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: KY 3018133) | |
| Enumeration Date | 2022-12-29 |
| Last Update Date | 2025-12-19 |