| NPI | 1699405845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 82523) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2018022886) |
| Enumeration Date | 2022-06-11 |
| Last Update Date | 2023-09-19 |