| NPI | 1306284922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN 1940) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN R 184593-4) |
| Enumeration Date | 2013-06-05 |
| Last Update Date | 2025-06-16 |