NPI | 1457782336 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 3076) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R1280845) |
Enumeration Date | 2013-12-03 |
Last Update Date | 2020-10-06 |