| NPI | 1104215383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK 89877) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: OK 89877) |
| Enumeration Date | 2015-01-12 |
| Last Update Date | 2024-11-09 |