| NPI | 1447966411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK 216160) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 5017469) |
| 363L00000X Nurse Practitioner (Licence: NC 5017469) | |
| Enumeration Date | 2023-01-24 |
| Last Update Date | 2024-01-17 |