| NPI | 1942436209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2019035087) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OK 107413) |
| 363LF0000X Nurse Practitioner, Family (Licence: KS 74918) | |
| Enumeration Date | 2009-06-01 |
| Last Update Date | 2022-09-01 |