| NPI | 1114251238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK R0118109) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 118109) |
| Enumeration Date | 2009-09-22 |
| Last Update Date | 2023-03-01 |