| NPI | 1285621680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK R0084568) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 086009) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2011-09-07 |