| NPI | 1881821643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN R205412-2) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209007587) |
| 363L00000X Nurse Practitioner (Licence: WA AP60196934) | |
| Enumeration Date | 2009-06-18 |
| Last Update Date | 2012-03-16 |