| NPI | 1588825723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SD SD-CNP CP000967) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: SD R033677) |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2015-07-23 |