| NPI | 1801381256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 2018022963) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 53-78314-081) |
| Enumeration Date | 2018-06-28 |
| Last Update Date | 2022-09-26 |