| NPI | 1588264881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MN 10652) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 1969603) |
| 163WG0000X Registered Nurse, General Practice (Licence: NM 75163) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: NM 75163) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-10-27 |
| Last Update Date | 2023-11-04 |