| NPI | 1881646347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 4372-33) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MN R-100621-0) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2014-02-04 |