| NPI | 1689497679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: KS TMP-162681) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: KS TMP-162681) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: KS TMP-162681) | |
| Enumeration Date | 2024-11-06 |
| Last Update Date | 2024-11-06 |