| NPI | 1548890833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN 9383) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 1811078) |
| Enumeration Date | 2020-01-25 |
| Last Update Date | 2023-02-15 |