| NPI | 1205235363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK 80761) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OK 0080761) |
| Enumeration Date | 2014-08-14 |
| Last Update Date | 2021-11-17 |