| NPI | 1942892146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK 200625) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OK 200625) |
| Enumeration Date | 2021-02-09 |
| Last Update Date | 2023-05-25 |