| NPI | 1780210765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-80371) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NM 59804) |
| Enumeration Date | 2020-03-21 |
| Last Update Date | 2021-07-16 |