NPI | 1003396904 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OK R0113179) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OK 113179) |
Enumeration Date | 2018-08-20 |
Last Update Date | 2025-07-17 |