| NPI | 1699405845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-82523-012) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OK 221043) |
| Enumeration Date | 2022-06-11 |
| Last Update Date | 2025-03-04 |