| NPI | 1982250569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MN 2191836) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: MN 2191836) |
| Enumeration Date | 2019-08-10 |
| Last Update Date | 2023-03-08 |