| NPI | 1376565325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN R138686-2) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: MN R13868627) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2019-09-14 |