| NPI | 1346941994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MN 10011) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: MN 10011) |
| Enumeration Date | 2023-03-10 |
| Last Update Date | 2024-08-22 |