| NPI | 1093172272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 9487535) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OK 0106028) |
| 163W00000X Registered Nurse (Licence: TX 1191282) | |
| 363LF0000X Nurse Practitioner, Family (Licence: OK 106028) | |
| Enumeration Date | 2016-01-19 |
| Last Update Date | 2025-02-26 |