| NPI | 1144587650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN R83926-8) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN R83926-8) |
| 163WC1500X Registered Nurse, Community Health (Licence: MN R83926-8) | |
| Enumeration Date | 2012-04-20 |
| Last Update Date | 2017-10-10 |