| NPI | 1245688928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: SD CP003314) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9344794) |
| 163W00000X Registered Nurse (Licence: TN 196881) | |
| 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: TN 31438) | |
| 363L00000X Nurse Practitioner (Licence: WA N360677930) | |
| 363L00000X Nurse Practitioner (Licence: NM 60350) | |
| 363L00000X Nurse Practitioner (Licence: TN 31438) | |
| Enumeration Date | 2016-06-02 |
| Last Update Date | 2024-09-11 |