| NPI | 1972164655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK 121540) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 1098427) |
| Enumeration Date | 2019-06-24 |
| Last Update Date | 2024-03-19 |