| NPI | 1346658507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MN R200319-9) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: MN R200319-9) |
| Enumeration Date | 2014-07-31 |
| Last Update Date | 2020-11-10 |