| NPI | 1013936731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MN R 152778-6) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 138615-30) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2012-08-21 |