| NPI | 1285171413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OK R0123174) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: OK R0123174) |
| 363LG0600X Nurse Practitioner Gerontology (Licence: OK R0123174) | |
| Enumeration Date | 2017-01-26 |
| Last Update Date | 2017-01-26 |