| NPI | 1679053813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2018030484) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OK 207237) |
| Enumeration Date | 2018-08-17 |
| Last Update Date | 2025-01-21 |