| NPI | 1982391967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: KS 13-113388-031) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2011037697) |
| Enumeration Date | 2023-04-20 |
| Last Update Date | 2023-04-20 |