| NPI | 1023689783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 8553) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 10939) |
| 363L00000X Nurse Practitioner (Licence: WI 10939) | |
| Enumeration Date | 2021-07-05 |
| Last Update Date | 2021-09-21 |