| NPI | 1295289064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN CNP 4805) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN R 237119-3) |
| Enumeration Date | 2016-08-10 |
| Last Update Date | 2021-04-06 |