| NPI | 1942929658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MN 9438) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: MN 9438) |
| Enumeration Date | 2022-08-25 |
| Last Update Date | 2024-01-03 |