| NPI | 1851644413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK 66986) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 829380) |
| Enumeration Date | 2012-10-19 |
| Last Update Date | 2016-09-14 |