| NPI | 1063844496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-76045-041) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 13-108275-041) |
| Enumeration Date | 2013-08-08 |
| Last Update Date | 2014-02-20 |