| NPI | 1184738734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: KS 13-36340-111) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 44008) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2007-07-08 |