| NPI | 1619788635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: OK 221785) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: OK R0133962) |
| Enumeration Date | 2025-01-17 |
| Last Update Date | 2025-02-11 |