| NPI | 1245740968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OK 109001) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OK 109001) |
| 207Q00000X Family Medicine (Licence: OK 109001) | |
| Enumeration Date | 2017-10-08 |
| Last Update Date | 2023-09-15 |