| NPI | 1578447686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-84560-031) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 13-135129-031) |
| Enumeration Date | 2025-08-01 |
| Last Update Date | 2025-08-01 |