| NPI | 1851636732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-79858-071) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 5089) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: KS 53-79858-071) | |
| Enumeration Date | 2012-12-04 |
| Last Update Date | 2023-02-15 |