| NPI | 1982465761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN 1279791) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WI 263976) |
| Enumeration Date | 2024-01-19 |
| Last Update Date | 2024-04-25 |