| NPI | 1174026868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-78008-111) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2021014136) |
| Enumeration Date | 2018-03-09 |
| Last Update Date | 2024-04-30 |