| NPI | 1750995585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK R0086052) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OK 86052) |
| Enumeration Date | 2020-08-31 |
| Last Update Date | 2021-08-03 |