| NPI | 1790481141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OK R0096923) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: OK 318188) |
| Enumeration Date | 2023-02-06 |
| Last Update Date | 2025-01-06 |