| NPI | 1023718053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 10095) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 2460602) |
| Enumeration Date | 2023-03-08 |
| Last Update Date | 2023-04-24 |