| NPI | 1851118178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MN 2469647) |
| Additional Taxonomies | 163WP2201X Registered Nurse, Ambulatory Care (Licence: MN 2469647) |
| Enumeration Date | 2024-09-26 |
| Last Update Date | 2025-04-11 |