| NPI | 1609334879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-78626-122) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2019006490) |
| Enumeration Date | 2019-03-06 |
| Last Update Date | 2022-02-09 |