NPI | 1982346607 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-80861-032) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2022000398) |
Enumeration Date | 2022-04-12 |
Last Update Date | 2022-04-12 |