| NPI | 1730747221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 7781) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN R214182-8) |
| Enumeration Date | 2019-05-30 |
| Last Update Date | 2024-02-09 |