| NPI | 1154020998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MO 2023010980) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: KS 53-81975-102) |
| Enumeration Date | 2023-03-01 |
| Last Update Date | 2023-08-18 |