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 |