| NPI | 1043668817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN CNP 4539) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ND R42796) |
| Enumeration Date | 2016-06-01 |
| Last Update Date | 2017-01-31 |