NPI | 1093076929 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 804) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R1490130) |
Enumeration Date | 2012-06-07 |
Last Update Date | 2021-10-29 |