| NPI | 1851026611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: KY 3018039) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1149369) |
| Enumeration Date | 2022-07-17 |
| Last Update Date | 2022-07-17 |