| NPI | 1922562784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 79719) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: KS 13-115932-061) |
| 363L00000X Nurse Practitioner (Licence: MO 2020030796) | |
| Enumeration Date | 2019-01-25 |
| Last Update Date | 2024-01-04 |