| NPI | 1730626391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-80652-041) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2017000785) |
| Enumeration Date | 2017-01-20 |
| Last Update Date | 2024-01-12 |