| NPI | 1942781158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2019015044) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 78736) |
| 163WE0003X Registered Nurse, Emergency (Licence: MO 2013031549) | |
| 163WE0003X Registered Nurse, Emergency (Licence: KS 14-133095-111) | |
| Enumeration Date | 2018-08-25 |
| Last Update Date | 2020-03-12 |