| NPI | 1437554482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MN 3084) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN R 223267-2) |
| Enumeration Date | 2014-11-01 |
| Last Update Date | 2021-02-25 |