NPI | 1235709296 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-80406) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 108703) |
Enumeration Date | 2021-06-30 |
Last Update Date | 2021-09-14 |