| NPI | 1336924836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN H176825) |
| Additional Taxonomies | 163WG0600X Registered Nurse, Gerontology (Licence: ND R45699) |
| Enumeration Date | 2023-08-31 |
| Last Update Date | 2025-04-16 |