| NPI | 1477364891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 364S00000X Clinical Nurse Specialist (Licence: OK 230540) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OK R0099596) |
| Enumeration Date | 2025-01-15 |
| Last Update Date | 2026-07-20 |