| NPI | 1144780255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN 10290) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OR 201905929) |
| 363LF0000X Nurse Practitioner, Family (Licence: OR F06191484) | |
| Enumeration Date | 2019-03-23 |
| Last Update Date | 2023-07-06 |