| NPI | 1215366380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MN CNP3823) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA RN199619) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: MN R158970-8) | |
| Enumeration Date | 2013-11-08 |
| Last Update Date | 2018-11-01 |