| NPI | 1477784924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OK 78334) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AR A03302) |
| Enumeration Date | 2009-07-31 |
| Last Update Date | 2009-09-28 |