| NPI | 1801484092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK 200931) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2021000403) |
| 163W00000X Registered Nurse (Licence: MO 2015004452) | |
| Enumeration Date | 2021-01-04 |
| Last Update Date | 2021-08-23 |