| NPI | 1437582160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 2013027911) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 53-78523) |
| Enumeration Date | 2013-08-16 |
| Last Update Date | 2025-05-16 |