| NPI | 1710714753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-83591-052) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2024039338) |
| Enumeration Date | 2024-09-16 |
| Last Update Date | 2025-05-02 |