| NPI | 1316495401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: MN CNP 4710) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: MN CNP 4710) |
| 363LG0600X Nurse Practitioner Gerontology (Licence: MN CNP 4710) | |
| Enumeration Date | 2016-09-16 |
| Last Update Date | 2016-09-16 |