| NPI | 1144749672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-77844-072) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 155240) |
| Enumeration Date | 2017-09-15 |
| Last Update Date | 2021-09-17 |