| NPI | 1467927657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SD CP001466) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN 7183) |
| Enumeration Date | 2018-10-04 |
| Last Update Date | 2024-06-26 |