| NPI | 1811952641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: MN R105679-4) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MN R105679-4) |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2013-03-08 |