| NPI | 1851351464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 45427) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 13-57736-092) |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2012-11-21 |