| NPI | 1992765457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK 90263) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 789876) |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2023-11-16 |