| NPI | 1619463056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WH0200X Registered Nurse, Home Health (Licence: MN 2029199) |
| Additional Taxonomies | 163WA2000X Registered Nurse, Administrator (Licence: MN 2029199) |
| Enumeration Date | 2018-07-09 |
| Last Update Date | 2018-07-09 |