| NPI | 1902321607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK R83620) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: OK R83620) |
| Enumeration Date | 2017-08-03 |
| Last Update Date | 2018-03-17 |