| NPI | 1932355666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 5223) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R 167224-6) |
| 363L00000X Nurse Practitioner (Licence: MN 2284) | |
| Enumeration Date | 2008-08-13 |
| Last Update Date | 2018-11-21 |