| NPI | 1669732103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN CNP5798) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN R2463980) |
| Enumeration Date | 2012-05-17 |
| Last Update Date | 2024-09-11 |