| NPI | 1053179242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 217179) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OK 1053179242) |
| Enumeration Date | 2024-03-12 |
| Last Update Date | 2026-02-10 |