| NPI | 1487261673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2020029105) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: KS 53-79497-042) |
| 363LF0000X Nurse Practitioner, Family (Licence: KS 53-79497-042) | |
| Enumeration Date | 2020-09-30 |
| Last Update Date | 2022-08-31 |