NPI | 1720330434 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 8918) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN R1941498) |
Enumeration Date | 2012-10-04 |
Last Update Date | 2022-04-13 |