| NPI | 1134627060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 5653) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN 5653) |
| Enumeration Date | 2018-01-25 |
| Last Update Date | 2024-01-30 |