| NPI | 1780540898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK 227226) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: OK R0115989) |
| Enumeration Date | 2026-01-02 |
| Last Update Date | 2026-01-26 |