| NPI | 1386924553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-75467-042) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN CNP3917) |
| 363L00000X Nurse Practitioner (Licence: NE 113043) | |
| 363L00000X Nurse Practitioner (Licence: KS TMP143425) | |
| 363LF0000X Nurse Practitioner, Family (Licence: AZ AP8767) | |
| Enumeration Date | 2011-08-19 |
| Last Update Date | 2023-03-20 |