| NPI | 1891233110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MN 363LP2300X) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: MN 363LG0600X) |
| Enumeration Date | 2017-02-07 |
| Last Update Date | 2017-04-27 |