| NPI | 1891776480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ND R15466) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ND PAC0047) |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2013-01-03 |