| NPI | 1851608178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: IN 71003368A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R 198898-5) |
| 363LA2200X Nurse Practitioner Adult Health (Licence: MN R198898-5) | |
| Enumeration Date | 2010-09-08 |
| Last Update Date | 2021-11-17 |