| NPI | 1780284729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OK 210707) |
| Additional Taxonomies | 246ZA2600X Specialist/Technologist, Other, Art, Medical (Licence: OK 1781) |
| Enumeration Date | 2020-10-29 |
| Last Update Date | 2025-07-08 |