| NPI | 1710350780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MN R 196646-0) |
| Additional Taxonomies | 163WI0600X Registered Nurse, Infection Control (Licence: MN R 196646-0) |
| Enumeration Date | 2015-11-12 |
| Last Update Date | 2015-11-12 |