| NPI | 1134629405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK 113330) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: OK 113330) |
| Enumeration Date | 2018-02-13 |
| Last Update Date | 2020-03-26 |