| NPI | 1457670903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN 457) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MN 457) |
| 363LF0000X Nurse Practitioner, Family (Licence: CO NP 10272) | |
| Enumeration Date | 2010-05-24 |
| Last Update Date | 2024-01-21 |