| NPI | 1962953158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: OK 84805) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: OK 84805) |
| Enumeration Date | 2016-10-22 |
| Last Update Date | 2016-10-22 |