| NPI | 1144905159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 10717) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 00000000) |
| Enumeration Date | 2023-06-19 |
| Last Update Date | 2023-09-27 |