| NPI | 1346083219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 11769) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 2310523) |
| 163W00000X Registered Nurse (Licence: GA RN262014) | |
| 363LF0000X Nurse Practitioner, Family (Licence: GA RN262014) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MN 11769) | |
| 163W00000X Registered Nurse (Licence: CA 95283925) | |
| Enumeration Date | 2024-06-17 |
| Last Update Date | 2024-08-01 |