| NPI | 1417544479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN 7821) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN 78211) |
| Enumeration Date | 2020-12-24 |
| Last Update Date | 2020-12-24 |