| NPI | 1992991129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN r1588372) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN 1588372) |
| Enumeration Date | 2007-09-20 |
| Last Update Date | 2020-10-28 |