| NPI | 1295486983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: KS 53-80910-051) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: KS 13-140864-051) |
| Enumeration Date | 2022-01-13 |
| Last Update Date | 2022-02-10 |