| NPI | 1639736150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MN 8162) |
| Additional Taxonomies | 163WH0200X Registered Nurse Home Health (Licence: MN 2331230) |
| Enumeration Date | 2019-05-20 |
| Last Update Date | 2021-04-30 |