| NPI | 1245654946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP132127) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OK 85882) |
| 363LF0000X Nurse Practitioner, Family (Licence: OK 85882) | |
| Enumeration Date | 2014-02-15 |
| Last Update Date | 2024-09-04 |