| NPI | 1457047144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AR 223847) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OK 220570) |
| 363LF0000X Nurse Practitioner, Family (Licence: MO 2023013715) | |
| Enumeration Date | 2023-04-14 |
| Last Update Date | 2025-07-01 |