| NPI | 1861006397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN 74) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 2097642) |
| 363LF0000X Nurse Practitioner, Family (Licence: MN 7) | |
| Enumeration Date | 2020-09-02 |
| Last Update Date | 2020-09-28 |