| NPI | 1841642535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 53-81393-121) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MO 2016000962) |
| 363LF0000X Nurse Practitioner, Family (Licence: MO 2019001965) | |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2025-01-31 |