| 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 |