| NPI | 1952064297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: SD CP002217) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SD F09211513) |
| Enumeration Date | 2021-10-13 |
| Last Update Date | 2023-01-19 |