| NPI | 1215452107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK R0097253) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: OK 97253) |
| Enumeration Date | 2017-08-11 |
| Last Update Date | 2020-09-02 |