| NPI | 1881178044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK 205227) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95009948) |
| Enumeration Date | 2018-09-23 |
| Last Update Date | 2025-06-16 |