NPI | 1780924092 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 1554) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R1832947) |
363LA2200X Nurse Practitioner, Adult Health (Licence: SD CP000776) | |
Enumeration Date | 2013-02-22 |
Last Update Date | 2020-10-05 |