| NPI | 1932599818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN 6590) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN APN0000019181) |
| 363LF0000X Nurse Practitioner, Family (Licence: IA A157205) | |
| Enumeration Date | 2015-01-29 |
| Last Update Date | 2020-09-09 |