| NPI | 1699405829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 83085) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 2023020399) |
| Enumeration Date | 2022-06-11 |
| Last Update Date | 2024-04-23 |