| NPI | 1568877827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 7786) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner Primary Care (Licence: ND R34884) |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2023-11-15 |