| NPI | 1598379844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: KS 53-79766) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NE 113242) |
| Enumeration Date | 2020-09-03 |
| Last Update Date | 2023-09-13 |