| NPI | 1144693169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN CNP4943) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209013457) |
| 363LF0000X Nurse Practitioner, Family (Licence: OR 201704860NP-PP) | |
| Enumeration Date | 2015-11-13 |
| Last Update Date | 2018-02-19 |