| 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 |