| NPI | 1386258770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-79500-042) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2023046341) |
| Enumeration Date | 2020-09-02 |
| Last Update Date | 2025-11-07 |