| NPI | 1811624810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OK 209389) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: OK 209389) |
| Enumeration Date | 2022-08-01 |
| Last Update Date | 2022-09-01 |