| NPI | 1780186908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: KS 53-78057-051) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: MO 2018004093) |
| Enumeration Date | 2018-03-03 |
| Last Update Date | 2018-03-03 |