| NPI | 1699339614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WH0200X Registered Nurse, Home Health (Licence: MN 390397) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 390397) |
| 163WH0200X Registered Nurse, Home Health (Licence: MN R-127815-8) | |
| 163WH0200X Registered Nurse, Home Health (Licence: MN R-1610059) | |
| Enumeration Date | 2019-04-25 |
| Last Update Date | 2019-04-25 |