| NPI | 1255797395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: KS 53-77308-061) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2010035284) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: MO 2016005872) | |
| Enumeration Date | 2016-01-05 |
| Last Update Date | 2019-09-23 |