| NPI | 1700998093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 44810) |
| Additional Taxonomies | 364SE0003X Clinical Nurse Specialist, Emergency (Licence: KS 44810) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2007-11-14 |