| NPI | 1588790695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MN A0712043) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: MN G0712007) |
| Enumeration Date | 2007-02-25 |
| Last Update Date | 2012-08-02 |