| NPI | 1215673363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OK 209028) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OK R0125411) |
| Enumeration Date | 2022-05-11 |
| Last Update Date | 2022-07-08 |