| NPI | 1366150690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 53-81821-072) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 13-149099-072) |
| 363L00000X Nurse Practitioner (Licence: KS TMP-161292) | |
| Enumeration Date | 2022-11-07 |
| Last Update Date | 2023-01-12 |