| NPI | 1437406907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN R1744404) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN 563) |
| Enumeration Date | 2012-08-14 |
| Last Update Date | 2022-11-22 |