NPI | 1215993407 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 2220) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SD CP000515) |
363LF0000X Nurse Practitioner, Family (Licence: MN R 137351-6) | |
Enumeration Date | 2006-04-25 |
Last Update Date | 2020-08-07 |