NPI | 1073870382 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK 92665) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: OK R92665) |
Enumeration Date | 2012-04-12 |
Last Update Date | 2021-11-11 |