| NPI | 1437439825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 1728) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R2134181) |
| 363L00000X Nurse Practitioner (Licence: WI 4511) | |
| Enumeration Date | 2011-08-17 |
| Last Update Date | 2020-10-06 |