| NPI | 1255008686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2021035406) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-80496-091) |
| Enumeration Date | 2021-08-24 |
| Last Update Date | 2024-04-19 |