| NPI | 1043988298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: SD CP002137) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SD R049685) |
| Enumeration Date | 2021-09-02 |
| Last Update Date | 2021-09-09 |