| NPI | 1548654460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK 102427) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP132241) |
| Enumeration Date | 2015-03-28 |
| Last Update Date | 2024-11-26 |