| NPI | 1841898186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: SD CP001881) |
| Additional Taxonomies | 208D00000X General Practice (Licence: SD CP001881) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-10-09 |
| Last Update Date | 2023-05-16 |