| NPI | 1003426396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AR 223719) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OK 86183) |
| Enumeration Date | 2020-08-03 |
| Last Update Date | 2023-07-25 |