| NPI | 1295101756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: KS 76886) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: KS 76886) |
| 363LF0000X Nurse Practitioner, Family (Licence: KS 76886) | |
| 363L00000X Nurse Practitioner (Licence: KS 76886) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: KS 76886) | |
| Enumeration Date | 2015-08-18 |
| Last Update Date | 2022-07-21 |