| NPI | 1376523530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK 98734) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 15655) |
| Enumeration Date | 2006-01-21 |
| Last Update Date | 2014-01-29 |