| NPI | 1699464545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 5382234112) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2020005062) |
| Enumeration Date | 2023-05-05 |
| Last Update Date | 2023-06-05 |