NPI | 1932742582 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 79002) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 2024032097) |
Enumeration Date | 2019-10-25 |
Last Update Date | 2024-09-25 |