| NPI | 1235935958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OK 228862) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OK 228862) |
| 363LF0000X Nurse Practitioner, Family (Licence: OK 228862) | |
| Enumeration Date | 2025-02-22 |
| Last Update Date | 2026-08-03 |