| NPI | 1821985227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 53-84484-032) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 13-150759) |
| Enumeration Date | 2025-06-19 |
| Last Update Date | 2026-06-09 |