| NPI | 1952123119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: OK 223142) |
| Additional Taxonomies | 163WE0003X Registered Nurse Emergency (Licence: OK R0134442) |
| Enumeration Date | 2024-10-29 |
| Last Update Date | 2025-05-21 |