NPI | 1003290685 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MN 3895) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN 3895) |
363LA2200X Nurse Practitioner, Adult Health (Licence: MN 3895) | |
363LG0600X Nurse Practitioner, Gerontology (Licence: MN 3895) | |
363LP2300X Nurse Practitioner, Primary Care (Licence: MN 3895) | |
Enumeration Date | 2015-07-14 |
Last Update Date | 2023-06-26 |