| NPI | 1528721263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-83381) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2024048958) |
| 363LF0000X Nurse Practitioner, Family (Licence: KS 53-83381-012) | |
| Enumeration Date | 2021-10-19 |
| Last Update Date | 2025-08-05 |