NPI | 1730797523 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OR 202213116NP-PP) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OK 104652) |
363LA2100X Nurse Practitioner, Acute Care (Licence: OK 104652) | |
363LF0000X Nurse Practitioner, Family (Licence: OK 104652) | |
Enumeration Date | 2020-07-17 |
Last Update Date | 2023-10-30 |