| NPI | 1568172591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN 9809) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN 1697742) |
| Enumeration Date | 2022-11-30 |
| Last Update Date | 2022-12-22 |