| NPI | 1851613467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 75958) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2005007561) |
| Enumeration Date | 2010-02-23 |
| Last Update Date | 2017-07-19 |