| NPI | 1114536547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN 7577) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11008116) |
| Enumeration Date | 2020-07-31 |
| Last Update Date | 2024-10-04 |