| NPI | 1184022733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MN CNP0662) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MN CNP 0662) |
| Enumeration Date | 2014-12-15 |
| Last Update Date | 2021-11-03 |