| NPI | 1457953705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: MO 2020008737) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: KS 53-79278-011) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: KS 53-79278-011) | |
| Enumeration Date | 2020-11-11 |
| Last Update Date | 2026-08-19 |