| NPI | 1407599251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 81207) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 147999) |
| Enumeration Date | 2022-04-19 |
| Last Update Date | 2022-07-01 |