| NPI | 1144567991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 75893) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: KS 53-75893-082) |
| Enumeration Date | 2013-01-14 |
| Last Update Date | 2023-09-20 |