| NPI | 1740695774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OK R0096294) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OK 96294) |
| Enumeration Date | 2014-06-28 |
| Last Update Date | 2022-11-21 |