| NPI | 1972574879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: MN R173337-6) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: TX 633535) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2021-03-17 |