| NPI | 1275960304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK 76980) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: OK 76980) |
| Enumeration Date | 2013-10-03 |
| Last Update Date | 2019-07-09 |