| NPI | 1801272133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK 103951) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OK 103951) |
| Enumeration Date | 2015-08-10 |
| Last Update Date | 2024-10-22 |