| NPI | 1689143414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 6308) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MN 6308) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: MN 6308) | |
| Enumeration Date | 2018-11-22 |
| Last Update Date | 2020-11-10 |