NPI | 1225711468 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-84069-032) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 2023011738) |
Enumeration Date | 2023-08-14 |
Last Update Date | 2025-03-18 |