| NPI | 1326767872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN 9448) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN 9448) |
| 363LF0000X Nurse Practitioner, Family (Licence: WI 1352733) | |
| Enumeration Date | 2022-08-26 |
| Last Update Date | 2025-02-19 |