| NPI | 1023947546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 85933) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 13-150769) |
| Enumeration Date | 2026-05-19 |
| Last Update Date | 2026-08-06 |