| NPI | 1558815522 |
|---|---|
| Former Name | JAE WON LEE |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 5905) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN F07161203) |
| Enumeration Date | 2016-08-08 |
| Last Update Date | 2018-07-11 |