| NPI | 1134680655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NM CNP-69401) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OK R0100796) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: OK 100796) | |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2023-01-13 |