| NPI | 1003279498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OK 102252) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OK 102252) |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2019-06-21 |