| NPI | 1033528740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 1958) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R1428937) |
| Enumeration Date | 2014-08-06 |
| Last Update Date | 2020-10-05 |