| NPI | 1821614264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 79470) |
| Additional Taxonomies | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: KS 79470) |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: KS 79470) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: MO 2023037909) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: KS 79470) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: KS 79470) | |
| Enumeration Date | 2020-06-22 |
| Last Update Date | 2026-04-16 |