| NPI | 1912743790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: KY 4026548) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: KY 1130739) |
| Enumeration Date | 2024-07-02 |
| Last Update Date | 2024-09-05 |