| NPI | 1861367005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: KY 4046104) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: KY 4046104) |
| Enumeration Date | 2025-10-08 |
| Last Update Date | 2025-12-18 |