| NPI | 1134503469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MN 6559) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MA RN2289187) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: MN 6559) | |
| Enumeration Date | 2015-07-16 |
| Last Update Date | 2021-08-16 |