| NPI | 1992219570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: MN 5651) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: MN 5651) |
| 363L00000X Nurse Practitioner (Licence: MN 5651) | |
| Enumeration Date | 2017-11-19 |
| Last Update Date | 2024-09-20 |