| NPI | 1811251424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MN R2073983) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: MN R2073983) |
| Enumeration Date | 2012-06-28 |
| Last Update Date | 2025-02-11 |