| NPI | 1356201644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK 226311) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 226311) |
| Enumeration Date | 2025-11-18 |
| Last Update Date | 2026-01-28 |