| NPI | 1386421527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OK 214516) |
| Additional Taxonomies | 364SG0600X Clinical Nurse Specialist, Gerontology (Licence: OK 214516) |
| Enumeration Date | 2023-09-12 |
| Last Update Date | 2023-12-08 |