| NPI | 1861026254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: OK 82808) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OK 82808) |
| Enumeration Date | 2020-02-25 |
| Last Update Date | 2020-03-31 |