| NPI | 1477121101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OK 204800) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OK R117640) |
| Enumeration Date | 2021-06-17 |
| Last Update Date | 2022-01-26 |