| NPI | 1083452874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SD CP003276) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: SD CP003276) |
| Enumeration Date | 2024-07-17 |
| Last Update Date | 2024-10-18 |