NPI | 1356882138 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: MN 5058) |
Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: MN CNP 5058) |
Enumeration Date | 2017-03-14 |
Last Update Date | 2022-03-01 |