| NPI | 1184073223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OK R0095332) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OK 95332) |
| 363LF0000X Nurse Practitioner, Family (Licence: OK R0095332) | |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2020-10-18 |