| NPI | 1609349265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: KS 78535) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS TMP-157777) |
| Enumeration Date | 2019-01-07 |
| Last Update Date | 2019-01-22 |