| NPI | 1487932984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 1730) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MN cnp1730) |
| Enumeration Date | 2011-08-01 |
| Last Update Date | 2020-10-05 |