| 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 |