| NPI | 1518485358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 53-77829) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CT 8233) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: WI 10205) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: CT 8233) | |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: WI 10205) | |
| Enumeration Date | 2017-08-31 |
| Last Update Date | 2022-11-15 |