| NPI | 1841659182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 4345) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN 206552-2) |
| Enumeration Date | 2016-02-15 |
| Last Update Date | 2024-06-18 |