| NPI | 1518735067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN 10978) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: MN 10978) |
| Enumeration Date | 2023-12-14 |
| Last Update Date | 2023-12-14 |