| NPI | 1447470075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MN R1168873) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: ND R20078) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2007-07-08 |