| NPI | 1356779789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 10600) |
| Additional Taxonomies | 163WC1500X Registered Nurse, Community Health (Licence: MN 21233) |
| 163WH0200X Registered Nurse, Home Health (Licence: MN 213799-7) | |
| Enumeration Date | 2013-10-22 |
| Last Update Date | 2023-08-25 |