| NPI | 1629791777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OK 210343) |
| Additional Taxonomies | 364SG0600X Clinical Nurse Specialist, Gerontology (Licence: OK 210343) |
| Enumeration Date | 2022-09-23 |
| Last Update Date | 2022-09-23 |