| NPI | 1033415195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: KS 53-78717-052) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2009022018) |
| 363L00000X Nurse Practitioner (Licence: MO 2019009085) | |
| Enumeration Date | 2011-02-07 |
| Last Update Date | 2021-05-03 |