| NPI | 1639830573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK 206441) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: OK R0112640) |
| Enumeration Date | 2022-01-03 |
| Last Update Date | 2022-06-28 |