| NPI | 1487816872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN 1401) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN R-098879-5) |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2020-09-18 |