Facts
- Status
- A
- Credential
- DC
- Type
- Individual
- Enumeration date
- 2006-01-26
- Last updated
- 2019-06-13
Specialties
Licenses
- License SD
- 902
Location
- Practice location
- 422 WHITTECAR AVE
- City
- GREGORY SD
- Postal code
- 575331341
- Phone
- 605-835-8701
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.