| NPI | 1407542293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OK R0078990) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OK 78990) |
| 363LF0000X Nurse Practitioner, Family (Licence: OK 212533) | |
| Enumeration Date | 2023-04-13 |
| Last Update Date | 2025-04-07 |