| NPI | 1477233997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 10519) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MN R2081328) |
| Enumeration Date | 2023-07-19 |
| Last Update Date | 2023-09-13 |