| NPI | 1609631225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 53-82973-061) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 53-82973-061) |
| Enumeration Date | 2024-02-14 |
| Last Update Date | 2024-03-07 |