| NPI | 1841764107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 53-78804-112) |
| Additional Taxonomies | 163WX0800X Registered Nurse, Orthopedic (Licence: KS 13-119488-112) |
| Enumeration Date | 2019-01-18 |
| Last Update Date | 2020-01-12 |