| NPI | 1568827947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM 77859) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN R-229298-4) |
| 163WC1500X Registered Nurse, Community Health (Licence: MN R-229298-4) | |
| 163WH0200X Registered Nurse, Home Health (Licence: MN R-229298-4) | |
| 163WM0102X Registered Nurse, Maternal Newborn (Licence: MN R-229298-4) | |
| 163WN0003X Registered Nurse, Neonatal, Low-Risk (Licence: MN R-229298-4) | |
| 163WP0200X Registered Nurse, Pediatrics (Licence: MN R-229298-4) | |
| 163WW0101X Registered Nurse, Women's Health Care, Ambulatory (Licence: MN R-229298-4) | |
| 163WX0002X Registered Nurse, Obstetric, High-Risk (Licence: MN R-229298-4) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MN 6398) | |
| Enumeration Date | 2015-12-29 |
| Last Update Date | 2025-03-02 |