| NPI | 1144817529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: KS TMP-159792) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 79914) |
| Enumeration Date | 2020-12-30 |
| Last Update Date | 2022-02-14 |