NPI | 1497433403 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 10678) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 1900714) |
Enumeration Date | 2023-07-10 |
Last Update Date | 2023-09-15 |