| NPI | 1447218326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 74831) |
| Additional Taxonomies | 364S00000X Clinical Nurse Specialist (Licence: KS 53-74831) |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2019-01-16 |