| NPI | 1003218876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN 10136) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 2512775) |
| 363LF0000X Nurse Practitioner, Family (Licence: OH COA.17029-NP) | |
| Enumeration Date | 2014-09-23 |
| Last Update Date | 2023-08-22 |