| NPI | 1649370784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: SD CP000481) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SD CP000481) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2019-07-03 |