| 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 |