| NPI | 1457136848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OK 223577) |
| Additional Taxonomies | 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: OH APRN.CNP.0034766) |
| Enumeration Date | 2023-08-25 |
| Last Update Date | 2025-11-25 |