| NPI | 1477276954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK 215249) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: OK 215249) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: OK 215249) | |
| Enumeration Date | 2022-09-21 |
| Last Update Date | 2025-10-30 |