| NPI | 1144773607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: WI 197567) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MN 13533) |
| Enumeration Date | 2016-08-01 |
| Last Update Date | 2025-11-03 |