| NPI | 1710385729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 0539) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN 1850013) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: MN CNP 0539) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN R 185001-3) | |
| Enumeration Date | 2014-12-08 |
| Last Update Date | 2020-10-05 |