| NPI | 1881687242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 74904) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OK 61786) |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2020-11-17 |