| NPI | 1861478190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN CNP2301) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN R 158074-9) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2018-01-11 |