| NPI | 1184041964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: KS 53-78403-032) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: CO APN.0991114-NP) |
| Enumeration Date | 2014-03-18 |
| Last Update Date | 2024-02-14 |