| NPI | 1912921255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK 202145) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2005000860) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2021-08-18 |