| NPI | 1215276407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN 1813487) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WI 224269-30) |
| Enumeration Date | 2013-02-07 |
| Last Update Date | 2019-02-20 |