| NPI | 1336738293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: OK 201903) |
| Additional Taxonomies | 163WG0000X Registered Nurse General Practice (Licence: OK R0129507) |
| Enumeration Date | 2021-01-14 |
| Last Update Date | 2022-11-09 |