| NPI | 1447564802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 2091) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R 200182-9) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: OH 11642) | |
| Enumeration Date | 2010-07-28 |
| Last Update Date | 2021-02-16 |