| NPI | 1215826037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OK 225851) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OK R0133031) |
| Enumeration Date | 2025-06-30 |
| Last Update Date | 2025-12-18 |