| NPI | 1336862721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 2022014836) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-81246-082) |
| 363LF0000X Nurse Practitioner, Family (Licence: MO 2022014836) | |
| Enumeration Date | 2022-09-21 |
| Last Update Date | 2024-03-21 |