| NPI | 1013047463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN CNP5548) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 2460283) |
| 363LF0000X Nurse Practitioner, Family (Licence: AZ AP5193) | |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2018-09-13 |