NPI | 1366858631 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 200) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R130630-5) |
Enumeration Date | 2014-07-08 |
Last Update Date | 2020-10-05 |