| NPI | 1992744486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK 59673) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 548476) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2023-08-16 |