| NPI | 1750831293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN CNP4797) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN 4797) |
| 363LF0000X Nurse Practitioner, Family (Licence: IA A145504) | |
| 363LF0000X Nurse Practitioner, Family (Licence: WI 7253) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MN R-204839-0) | |
| 363LF0000X Nurse Practitioner, Family (Licence: WI 23992) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MN 4797) | |
| Enumeration Date | 2016-10-07 |
| Last Update Date | 2023-01-18 |