| NPI | 1962221622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner Gerontology (Licence: MN 11928) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN 11928) |
| Enumeration Date | 2024-10-09 |
| Last Update Date | 2024-10-09 |