| NPI | 1841785912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN 5909) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 201231-3) |
| Enumeration Date | 2018-06-29 |
| Last Update Date | 2024-06-11 |