| NPI | 1033793302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: MO 2020037660) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-80295-062) |
| 363LF0000X Nurse Practitioner, Family (Licence: MO 2020037660) | |
| Enumeration Date | 2021-05-11 |
| Last Update Date | 2024-09-04 |