| NPI | 1053806455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SD CP001399) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SD r036441) |
| 363L00000X Nurse Practitioner (Licence: SD cp001399) | |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2023-02-07 |