| NPI | 1144893579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-79721-081) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IA A164156) |
| Enumeration Date | 2021-07-22 |
| Last Update Date | 2021-07-22 |