| NPI | 1952847733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3011036) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: KY 3011036) |
| Enumeration Date | 2017-01-17 |
| Last Update Date | 2018-02-20 |