| NPI | 1811672843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 53-84553-081) |
| Additional Taxonomies | 163WX0800X Registered Nurse, Orthopedic (Licence: KS 13-152467-081) |
| Enumeration Date | 2023-06-19 |
| Last Update Date | 2025-08-08 |