| NPI | 1528045465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 1605) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MN R1317019) |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2025-06-27 |