| NPI | 1184211187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK 201449) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: OK 132425) |
| 363LF0000X Nurse Practitioner, Family (Licence: AR 214768) | |
| Enumeration Date | 2020-12-23 |
| Last Update Date | 2022-09-02 |