NPI | 1285830844 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 1411) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R 134445-1) |
Enumeration Date | 2007-06-21 |
Last Update Date | 2020-08-07 |