| NPI | 1750693784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: ND R30105) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: MN R 143972-2) |
| Enumeration Date | 2010-07-07 |
| Last Update Date | 2022-07-22 |