| NPI | 1013491141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK 113279) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OK R0113279) |
| Enumeration Date | 2018-09-25 |
| Last Update Date | 2022-12-25 |