| NPI | 1528540671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MN 6201) |
| Additional Taxonomies | 163WX0003X Registered Nurse, Obstetric, Inpatient (Licence: MN R1907490) |
| Enumeration Date | 2018-09-05 |
| Last Update Date | 2018-09-28 |