| NPI | 1396525705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: KS 53-82618-121) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9379303) |
| Enumeration Date | 2023-10-03 |
| Last Update Date | 2023-10-19 |