| NPI | 1083162903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-77363-061) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: KS 77363) |
| 363LF0000X Nurse Practitioner, Family (Licence: OH 0028215) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 1007542) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MO 2016044499) | |
| 363LF0000X Nurse Practitioner, Family (Licence: IA A158626) | |
| Enumeration Date | 2016-09-20 |
| Last Update Date | 2022-08-31 |