| NPI | 1306021571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK 79164) |
| Additional Taxonomies | 364SE0003X Clinical Nurse Specialist, Emergency (Licence: OK 73164) |
| Enumeration Date | 2008-01-07 |
| Last Update Date | 2014-07-08 |