| NPI | 1467882613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MN F0913331) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: MN R175707-7) |
| Enumeration Date | 2013-11-24 |
| Last Update Date | 2014-01-17 |