| NPI | 1861990566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 78038) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2018001755) |
| Enumeration Date | 2018-01-28 |
| Last Update Date | 2021-07-27 |