| NPI | 1639699663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9475085) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OK 105878) |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2018-07-03 |