| NPI | 1104418458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 82969) |
| Enumeration Date | 2021-02-08 |
| Last Update Date | 2024-04-16 |