| NPI | 1497533665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 53-82437-042) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 13-144913-042) |
| Enumeration Date | 2023-09-19 |
| Last Update Date | 2023-09-19 |