| NPI | 1417927138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MN CNP1528) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R113511-0) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2017-04-26 |