| NPI | 1124698733 |
|---|---|
| Former Name | DONG SU PARK |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95223747) |
| Additional Taxonomies | 163WC1500X Registered Nurse, Community Health (Licence: CA 561016) |
| Enumeration Date | 2021-06-26 |
| Last Update Date | 2021-06-26 |