| NPI | 1588018014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ND R47004) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OK 77628) |
| 363LF0000X Nurse Practitioner, Family (Licence: OK 77628) | |
| Enumeration Date | 2016-04-21 |
| Last Update Date | 2018-12-20 |