| NPI | 1033342522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 647) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN R 160388-8) |
| Enumeration Date | 2009-08-31 |
| Last Update Date | 2023-05-09 |