| NPI | 1023567989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5017300) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: OK 107434) |
| 363LF0000X Nurse Practitioner, Family (Licence: OK 107434) | |
| Enumeration Date | 2016-10-03 |
| Last Update Date | 2025-03-25 |