| NPI | 1669728465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MN CNP 1996) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MN R-128779-6) |
| Enumeration Date | 2012-07-30 |
| Last Update Date | 2016-02-15 |