| NPI | 1942177415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-84884-021) |
| Additional Taxonomies | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: KS 53-84884-021) |
| Enumeration Date | 2025-10-20 |
| Last Update Date | 2025-10-30 |