| NPI | 1245003466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK 200875) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: M0984509) |
| 163WF0300X Registered Nurse, Flight (Licence: OK 200875) | |
| Enumeration Date | 2023-10-31 |
| Last Update Date | 2024-10-08 |