| NPI | 1851613228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3006373) |
| Additional Taxonomies | 364S00000X Clinical Nurse Specialist (Licence: KY 6373S) |
| Enumeration Date | 2010-02-25 |
| Last Update Date | 2015-10-26 |