| NPI | 1295174399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MN R175640-5) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: MN R175640-5) |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2013-10-18 |