| NPI | 1215692702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OK 204622) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OK 204622) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: OK 204622) | |
| Enumeration Date | 2021-11-01 |
| Last Update Date | 2023-02-16 |