| NPI | 1811028673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 141364) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OK 66851) |
| 363L00000X Nurse Practitioner (Licence: KS 45922) | |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2018-10-05 |