| NPI | 1356270227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MN 13463) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MN 2316297) |
| Enumeration Date | 2026-05-18 |
| Last Update Date | 2026-08-05 |