| NPI | 1275427320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-84384-122) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2025005038) |
| Enumeration Date | 2025-06-04 |
| Last Update Date | 2025-07-28 |