| NPI | 1760148480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-80379-052) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 53-80379-052) |
| Enumeration Date | 2021-11-17 |
| Last Update Date | 2023-03-15 |