| NPI | 1407236292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 7451) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN 7451) |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2023-09-22 |