| NPI | 1235899139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK 216734) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OK R0101628) |
| Enumeration Date | 2021-12-20 |
| Last Update Date | 2024-04-04 |