| NPI | 1326782566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 53-82285-011) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2019002355) |
| Enumeration Date | 2022-04-25 |
| Last Update Date | 2024-04-01 |