| NPI | 1609315845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 77585) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 13-111992-022) |
| Enumeration Date | 2017-02-21 |
| Last Update Date | 2017-04-03 |