| 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 |