| NPI | 1891637856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 4053872) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 11046637) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: KY 4053872) | |
| Enumeration Date | 2026-04-08 |
| Last Update Date | 2026-07-31 |