| NPI | 1194450528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 53-81419) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2018009895) |
| Enumeration Date | 2022-07-20 |
| Last Update Date | 2022-07-27 |