| NPI | 1457004970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: OK 215227) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: OK 215227) |
| Enumeration Date | 2022-02-03 |
| Last Update Date | 2023-11-29 |