| NPI | 1538564729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OK 87529) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: OK 87529) |
| Enumeration Date | 2014-10-30 |
| Last Update Date | 2021-05-24 |