| NPI | 1699445585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OK 205439) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OK R0112335) |
| Enumeration Date | 2021-09-14 |
| Last Update Date | 2021-09-14 |