| NPI | 1538894100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 9535) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 1994652) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-07-19 |
| Last Update Date | 2022-11-28 |