| NPI | 1730701947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 79459) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 137795) |
| 363LF0000X Nurse Practitioner, Family (Licence: OK 137124) | |
| Enumeration Date | 2020-05-11 |
| Last Update Date | 2024-04-08 |