| NPI | 1861058455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: KS 78860) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 141628) |
| Enumeration Date | 2019-05-20 |
| Last Update Date | 2023-10-26 |