| NPI | 1710439401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MN 6436) |
| Additional Taxonomies | 163WE0003X Registered Nurse Emergency (Licence: MN R157123-7) |
| Enumeration Date | 2016-10-27 |
| Last Update Date | 2020-12-29 |