| NPI | 1336217900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 7888) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AR A003595) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2021-01-22 |