NPI | 1205439171 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: SD CP001895) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SD CP001895) |
Enumeration Date | 2020-11-20 |
Last Update Date | 2023-04-04 |