| NPI | 1144953837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK 208784) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OK R0127582) |
| Enumeration Date | 2022-07-08 |
| Last Update Date | 2022-08-22 |