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 |