| NPI | 1033759923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 59-79171-121) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: KS 59-79171-121) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: KS 59-79171-121) | |
| Enumeration Date | 2020-01-09 |
| Last Update Date | 2020-01-09 |