| NPI | 1093252439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK 0123709) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN APN0000020958) |
| Enumeration Date | 2017-01-24 |
| Last Update Date | 2017-01-24 |