| 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 |