| NPI | 1891494043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MN 9982) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: MN 2468270) |
| Enumeration Date | 2023-02-27 |
| Last Update Date | 2023-03-14 |