| NPI | 1225573249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN 8164) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2017000943) |
| Enumeration Date | 2016-12-29 |
| Last Update Date | 2024-02-23 |