| NPI | 1730772716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: OK 201465) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OK R0117181) |
| Enumeration Date | 2021-02-19 |
| Last Update Date | 2021-03-03 |