| NPI | 1205481405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ND R38926) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN 9686) |
| Enumeration Date | 2019-08-05 |
| Last Update Date | 2022-11-21 |