| NPI | 1457981177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11020077) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OK 110568) |
| Enumeration Date | 2020-01-22 |
| Last Update Date | 2023-12-22 |