| NPI | 1134672264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 4622) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MN CNP 4622) |
| Enumeration Date | 2016-07-25 |
| Last Update Date | 2020-09-30 |