| NPI | 1629544028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 5383954042) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 136082) |
| Enumeration Date | 2018-10-23 |
| Last Update Date | 2025-01-16 |