| NPI | 1982187274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: KS 53-78418) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: KS 14-140762-091) |
| Enumeration Date | 2018-09-12 |
| Last Update Date | 2025-02-21 |