NPI | 1124707443 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 10431) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN 10431) |
Enumeration Date | 2023-07-13 |
Last Update Date | 2023-10-02 |