| NPI | 1235692443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OK 109952) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: OK 109952) |
| 363LS0200X Nurse Practitioner, School (Licence: OK 109954) | |
| Enumeration Date | 2019-04-13 |
| Last Update Date | 2019-10-22 |