NPI | 1104805340 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 642) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R 145566-7) |
Enumeration Date | 2006-01-16 |
Last Update Date | 2024-11-08 |