| NPI | 1912452285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: SD CP001138) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SD CP001138) |
| Enumeration Date | 2016-08-16 |
| Last Update Date | 2021-11-22 |