| NPI | 1336493493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: MN 2118) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R 176964-1) |
| Enumeration Date | 2012-10-28 |
| Last Update Date | 2022-04-18 |