| NPI | 1033728555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-79651-011) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 13-113835-011) |
| Enumeration Date | 2020-07-30 |
| Last Update Date | 2020-09-15 |