| NPI | 1316773013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 12063) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN 12063) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: MN 2458208) | |
| Enumeration Date | 2024-09-10 |
| Last Update Date | 2024-11-27 |