| NPI | 1144785627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 6377) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN 6377) |
| 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: MN 0268) | |
| Enumeration Date | 2019-02-08 |
| Last Update Date | 2020-08-10 |