| NPI | 1710596580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-81355-102) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: KS 14-142454-102) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: MO 2015018003) | |
| Enumeration Date | 2020-07-28 |
| Last Update Date | 2024-04-01 |