| NPI | 1275293151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: SD R039978) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: SD CP002305) |
| Enumeration Date | 2021-12-20 |
| Last Update Date | 2022-02-12 |