NPI | 1710472493 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 5979) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 8582) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2018-06-26 |
Last Update Date | 2020-10-27 |