| NPI | 1053866541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-79163-032) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OK 0121556) |
| Enumeration Date | 2016-08-24 |
| Last Update Date | 2020-11-19 |