NPI | 1356786685 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN R 113240-1) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN R 113240-1) |
Enumeration Date | 2013-04-30 |
Last Update Date | 2013-04-30 |