NPI | 1215915525 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 60) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R 097949-0) |
Enumeration Date | 2006-01-06 |
Last Update Date | 2023-02-10 |