NPI | 1780921320 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-75903-041) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2013009798) |
Enumeration Date | 2013-01-15 |
Last Update Date | 2020-12-22 |