| NPI | 1942879002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK 202490) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 1048619) |
| Enumeration Date | 2021-06-23 |
| Last Update Date | 2024-04-08 |