| NPI | 1336255132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN 3490) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN R144870-0) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2022-05-17 |