| NPI | 1194439935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN 10126) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN F12220553) |
| Enumeration Date | 2023-01-06 |
| Last Update Date | 2023-06-28 |