| NPI | 1225310873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN 6345) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WI 4554-33) |
| Enumeration Date | 2011-09-09 |
| Last Update Date | 2019-11-27 |