| NPI | 1033687785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 2018035927) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 78397) |
| Enumeration Date | 2018-11-10 |
| Last Update Date | 2024-05-08 |