| NPI | 1235770231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SD CP001641) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN 7069) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: SD CP001641) | |
| Enumeration Date | 2019-10-01 |
| Last Update Date | 2023-08-21 |