| NPI | 1316263569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 4931-33) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN R 186591-4) |
| Enumeration Date | 2010-04-13 |
| Last Update Date | 2018-08-27 |