| NPI | 1033824669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-81876) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS TMP-161372) |
| Enumeration Date | 2023-01-18 |
| Last Update Date | 2025-01-20 |