| NPI | 1144554213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN R 145891-0) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN 1532) |
| Enumeration Date | 2009-09-23 |
| Last Update Date | 2020-08-10 |